How we recall information and its impact in reviewing for USMLE.

The USMLE is the type of exam that tests not only your knowledge and mastery of medicine but also your ability to recall those facts. What you cannot recall, usually in the space of a minute or less, you do not know as far as the USMLE is concerned. 🙁

There are actually 4 types of recall:

Immediate Recall. These are concepts you can recall with a snap of a finger. In order to do well in the exam, this is the type of recall you need for most of the concepts tested in USMLE.

Aided Recall. These are concepts you can recall with some cues. That’s why mnemonics are a favorite. That is also why q’s are increasingly 2 to 3 steps since the choices for a typical q can aid recall. This type of recall is generally slower than immediate recall, hence a time killer in a timed exam like USMLE. However, there are ways to make this type of recall effective for you, that explains the usefulness of outline notes vs. study notes.

Familiar Recall. These are concepts you are familiar with but a little faded. It requires a lot of prompting and cues to remember. A lot of times when you learn new concepts, but forget it after sometime, it is in the form of familiar recall.

Learnable Recall. These are concepts that you have learned a long long time ago that you’ve literally forgotten. However, it will be easier for you to relearn them than those who did not know about them in the first place.

In order to do well in the exam, you need to put as many information in Immediate recall as much as possible. Now about 1/3 of Step 1 is pure recall. Another 3rd requires some analysis but if you can recall it you can answer it. And about 1/3 requires extensive analysis and since you have about a minute to answer the questions, the faster you can recall the information, the more time you have for analysis. Fast recall is also very important in the first 2 types of questions, since it will give you much more time for the more difficult part of the examination that requires more extensive analysis.

Generally Aided recall is not as good as Immediate recall. Although Mnemonics can help, having important frequently tested concepts stored in your Knowledge Bank (KB) as mnemonics can be disastrous. Time in the USMLE is a precious commodity and aided recall may just be slow enough to harm your score. However, there is a way to use aided recall to your advantage. With the sheer volume of medical knowledge base, it is impossible to put everything in immediate recall. But if you can use information stored in immediate recall as the trigger for recalling information in aided recall, it can improve your performance tremendously. 🙂

This is the basis for writing outline notes for lectures and textbooks. The outline notes are the information you need to put in immediate recall, with all the other information from the lecture or textbooks in aided recall to be triggered by the information you have mastered in your outline notes. This is the basis for the popularity of the FIRST AID and BRS series. However, outline notes contain only the bare minimum of information you need to know. Without the additional information from the texts and lectures, there is no additional information to be recalled when you need it for the exam. Hence, the importance of Study Notes like Kaplan for your review. But a basic problem of Kaplan Notes are that they are also trying to serve as outline notes and therefore the perennial complaint that Kaplan Notes are not enough for Step 1. 😐

Therefore, it is good study methodology to write outline notes from your readings. If you chose to use First Aid or BRS, remember they are just outline notes and you may need to read up on additional topics in order to do well in the exam.